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NPI Code Detail

MEDICARE: MR. JASON KANE VANNOY MPT

MEDICARE: MR. JASON KANE VANNOY MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA00745300NJ

General Provider Information

NPI Number : 1770700213
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON KANE VANNOY MPT
Provider Business Mailing Address
First Line : 333 RIVER ST APT 603
Second Line :
City : HOBOKEN
State : NJ
Zip : 07030-5862
Country : US
Telephone Number : 201-683-3795
Fax Number :
Provider Business Practice Location Address
First Line : 1050 WALL ST W STE 200
Second Line :
City : LYNDHURST
State : NJ
Zip : 07071-3615
Country : US
Telephone Number : 201-531-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 07/08/2007

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